The Many Faces of Malnutrition

When we think about malnutrition, and its associated adjective, malnourished, it can be common to find ourselves picturing familiar images from media and public campaigns – often from sub-Saharan Africa or South Asia – warning of famines, food crises and starvation. As audiences of this news, we are often told that the disasters are due to adverse weather conditions such as drought leading to failed harvests and food shortages. However, as current events in Nigeria and Yemen are tragically demonstrating, it is just as often the case that hunger arises not directly out of problems of food production, but out of situations of conflict or negligent governance. Many people struggling to feed themselves may not be subsistence farmers, but those whose wages do not stretch to meet rising prices. It could also be those whose geographical location – perhaps when home situates you between warring factions, you have been displaced or where distribution networks have been deliberately disrupted – renders them unable to physically access food sources. Food’s centrality to sustaining every single human makes it vulnerable to exploitation as a strategic political resource. This can be a power for good, but sadly all too often it becomes a tool of repression.

Malnutrition is often associated with the developing world. Photo: Medscape

Realising that hunger is in large part a phenomenon of insufficient access rather than inadequate supply opens up the possibility that the condition I mentioned above – malnutrition – could be found even in places where food is abundant. If we shift our focus away from the production of food, towards how people obtain it, we can begin to understand how malnutrition is a very real problem in the United Kingdom. Despite supermarket shelves heaving with products, more and more people are being hospitalised in a malnourished state. Worryingly, currently around a third of people admitted to hospital in Britain are either malnourished or at risk of becoming so, but the situation becomes even more startling when one considers that 93% of people with malnutrition are suffering at home. Anyone can be susceptible to becoming undernourished, but there are certain segments of society that are particularly vulnerable. These include people with chronic health conditions, those suffering from progressive diseases such as cancer, and the elderly. It is the latter group that I would like to focus on a little more closely.

The elderly are especially prone to undernourishment. Copyright: Getty Images.

Undernourishment occurs when the body does not obtain sufficient nutrients, causing harmful changes to bodily form and function. It occurs in older people for a number of reasons. Firstly, physical changes that the body undergoes in older age can make it hard both to shop for food and to consume meals. Limited mobility, due either to physical frailty or the revoking of driving licences through poor eyesight, can mean that previously reliable methods of food provisioning (for example, from out-of-town supermarkets) become impossible without support from others. For elderly people without a support network, the decline in retail options at a local level, such as corner shops, has meant a restriction of the ways in which they can access food. On top of this, difficulties with chewing and swallowing can mean that mealtimes become daunting, and certain medications commonly taken by the elderly make it difficult for the body to absorb nutrients.

Traditionally, services such as ‘meals on wheels’ have helped to overcome the type of problems mentioned above by bringing nutritious, appropriate meals to older people at home, targeting a population known to be predisposed to nutritional challenges. However, concerningly, coverage has fallen by over 80% in fewer than 10 years amid cuts to local authority budgets imposed by the UK government. Councils are being forced to find huge savings and withdrawal of home delivery services to the elderly is often a result. In this context, it is sadly unsurprising that hospital admissions for malnutrition have trebled in a decade. As is the case with the suffering of people in developing countries that I discussed earlier, political forces here are complicit in the process of individuals becoming unable to nourish themselves.

Besides the ramifications this state of affairs has for older people’s wellbeing (undernutrition is associated with depression, apathy and self neglect), which are an unnecessary and shameful indignity in their own right, the government’s course of action is also short-sighted from a financial point of view. Malnourished people are weaker, more prone to falls, and visit their GPs at double the rate of well-nourished individuals. They are also admitted to hospital three times as often, and remain an inpatient on average three days longer. With many hospitals already struggling to attend to people in their care, the humanitarian and financial consequences of continued elderly malnutrition could overwhelm the NHS.

Fortunately, with enough commitment and political will, malnutrition is a problem that can be addressed. Charities such as Age UK are working hard to fill the void left by local authorities, liaising with supermarkets and volunteers to provide alternative food shopping arrangements such as telephone ordering and home delivery which allow people to remain well-nourished whilst in their own homes. The Malnutrition Task Force, an independent alliance of health and social care experts, is another organisation committed to researching and disseminating best practice in the timely detection and subsequent treatment of malnutrition, as well as fighting to increase public awareness of this growing problem.

And hopefully, with rising recognition of the many faces of malnutrition here in the UK, we as the wider public can use that awareness to accelerate positive changes in the nutritional status of older people – whether that be through joining a campaign against cuts to social care, volunteering with a charity to assist older people with their shopping, or simply cooking up an extra meal portion to take round to an elderly neighbour. With the right resources, we can fight the malnutrition in our midst.